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Understanding Asthma

Treatment

How Do I Know If I Have Asthma?

You can suspect asthma based on the symptoms described above. Your doctor will ask you many other questions and will listen to your lungs for wheezing. Some doctors may then prescribe an asthma medication (usually an inhaler), ask you to take it for a few weeks, and then schedule a return visit to see if the medication reduced your respiratory symptoms. The "gold standard" test to confirm asthma is a spirometry test, done before and 15 minutes after you inhale a bronchodilator (usually albuterol).

Many primary care physicians now have spirometers in their office. If the results show that you have airway obstruction which is improved after the bronchodilator, the probability that your respiratory symptoms were due to asthma is very high. However, spirometry is often normal in people with asthma during days without symptoms.

The doctor can then order another breathing test called a methacholine challenge test which determines the degree of twitchiness of your airways. There are many other tests your doctor may order including allergy skin tests (recommended at least once for almost all patients with asthma), allergy blood tests (eosinophil count or IgE levels), and perhaps a chest X-ray (which is normal in people who have asthma but no other lung diseases).

What Are the Treatments?

Asthma is usually a lifelong (chronic) disease. If you have asthma, you should see a doctor regularly. Therefore, treatment requires several steps:

• Monitoring daily asthma symptoms and need for rescue medication in an asthma diary (which you can download from WebMD and print)
• Avoiding your asthma triggers.
• Taking medications daily that control inflammation and prevent chronic symptoms (long-term-control medications).
• Ready availability of medications to treat asthma attacks when they occur (quick-relief medications such as albuterolor when exacerbations begin (Prednisone).

Your Asthma Action Plan

Following a diagnosis of asthma, your first step should be to work with your doctor to develop a treatment plan. Ask your doctor for the resulting written asthma action plan, which includes what you should do when you fall from the green zone of good control into the yellow or red zones. You can download one from WebMD, print it and ask your doctor to complete it.

Adding monitoring of lung function can improve the ability of some people with asthma to verify that their asthma control is worsening. Discuss the potential value of buying a $20-60 peak flow meter (such as the Personal Best) or pocket spirometer (such as the PiKo-1). You can add the readings to your asthma diary and use them as part of your asthma action plan. As with any medical condition, prevention is the best approach.

Medications

There are two general types of asthma medications:

• Anti-inflammatory drugs are taken daily to control asthma and prevent asthma attacks. Inhaled corticosteroids are the most popular and most likely to be effective anti-inflammatory medications for most people suffering from asthma. They reduce swelling and mucus production in the airways making the airways less likely to react to triggers. Inhaled corticosteroids include beclomethasone (QVAR), budesonide (Pulmicort), fluticasone (Flovent), triamcinolone (Azmacort), and flunisolide (Aerobid), all of which are usually taken twice-a-day, and the newly released mometasone (Asmanex) which may control asthma in some patients when taken just once-a-day.

Two other popular types of anti-inflammatory medications include the leukotriene modifier pills monteleukast (Singulair), which can be taken just once a day, zafirlukast (Accolate) taken twice a day, and zielutin (Zyflo) taken four times a day. The third type of anti-inflammatory medication are the inhaled cromones: cromolyn (Intal) and nedocromil (Tilade). The leukotriene modifier and cromone medications are effective asthma controllers for about half of those with mild asthma, and have the advantage of being very safe.

• Bronchodilators relieve the symptoms of asthmas by temporarily relaxing the muscle bands that tighten around the airways. As a result, breathing improves for about four hours for the short-acting bronchodilators and for about 12 hours for the long-acting inhaled bronchodilators Caffeine is a short-acting bronchodilator found in many beverages, but it is less effective and more likely to cause side-effects when compared to prescription bronchodilators. Short-acting inhaled bronchodilators include the highly popular rescue inhaler albuterol (Ventolin, Proventil, and generic, called salbutamol in Europe) and the new L-albuterol (Xopenex), which currently requires a nebulizer, with the potential advantage of fewer side-effects for some patients. Long-acting inhaled bronchodilators include salmeterol (Serevent) and formoterol (Foradil or Oxis). When an inhaled corticosteroid is not adequately controlling asthma, a long-acting bronchodilator is often added. Two inhalers combine these two types of asthma controller medications: the highly popular Advair Diskus (fluticasone in one of three doses, plus salmeterol) and the Symbicort Turbuhaler (budesonide plus formoterol, not yet available in the United States).

WARNING: Bronchodilators are potent drugs. If overused, they can cause dangerous side effects such as high blood pressure and fast or irregular heart beats (arrhythmias). If you are using your short-acting rescue bronchodilator more than twice a week because of asthma symptoms, talk to your doctor. Your asthma needs to be controlled better.

A new type of asthma medicine was released in 2003 in the United States and more recently in other countries. This anti-IgE drug, omalzimab (Xolair), is an injection usually taken once every 2-4 weeks, which works by inhibiting the allergic reaction that often causes constriction of the airways. Because of its high cost, Xolair is usually reserved for patients with difficult-to-control allergic asthma.

There are also some over-the-counter (OTC) medicines purported to treat asthma, including Primatene Mist (epinephrine) and Bronkaid Mist (epinephrine). These drugs are very short-acting bronchodilators, relaxing the muscles around the airways. They provide relief of symptoms for up to an hour, but they don't prevent asthma attacks and are much more likely to cause side-effects (including dangerous abnormal heart rhythms) when compared to prescription bronchodilators. They aren't recommended for people with chronic asthma.

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